Chloroform: The Quest for Oblivion (review)

Chloroform—the name conjures up a nineteenth-century physician administering anesthesia with a handkerchief. In the twentieth century, it is central to many a spy thriller: an unsuspecting victim passes out without a struggle shortly after a handkerchief soaked in the liquid is passed under the nose. In this remarkable book, Linda Stratmann traces the history of the second-oldest effective surgical anesthetic agent from its development in the late 1840s until its demise in the 1950s and 1960s.

The first chapter of the book recounts the history of the quest for anesthesia from antiquity through the discovery and use of ether as an anesthetic agent; while Stratmann skips over quite a bit, this is a tight and concise summary of events. Chapter 2 begins the chloroform story in earnest, tracing the roots of the discovery of the agent from the shores of Lake Ontario to the Victorian drawing room of the professor of midwifery in Edinburgh. In a scene that raises the hackles of even the most seasoned anesthesiologist, James Young Simpson and his colleagues inhale the vapors of this magnificent agent after a full meal. It amazes the current student of anesthesia that they did not all aspirate their dinners and die!

Stratmann's chapter on Queen Victoria's use of chloroform for her last two births, as well as the entire controversy concerning obstetrical anesthesia, is well recounted and fresh. Perhaps one of the best-known stories in the history of anesthesiology, it is handled here with a completeness rarely found in the standard histories of the subject. What is remarkable is that in recounting John Snow's groundbreaking work in creating anesthesia "à la reine," the author focuses not only on Queen Victoria but on other prominent patients of equal importance to the story. For example, the anesthetic of the daughter of the archbishop of Canterbury is described; this anesthetic is often omitted from conventional histories.

What makes this book enjoyable to the historian of anesthesia comes in the later chapters dealing with the criminal abuse of chloroform. Stratmann presents a cogent argument against the standard Hollywood portrayal of chloroform as an agent that would render the victim unconscious almost instantaneously; rather, the target would struggle and most likely cry out—just the opposite of the perpetrated myth. In several chapters, the known criminal use of the agent is detailed. The work is well done and fully understandable from medical, historical, and criminal perspectives.

In the final chapter, Stratmann chronicles the decline and disuse of chloroform. The agent provokes long-term, deadly liver complications when given in overdoses; by the time the copper kettle emerged in the early 1950s, which would have allowed chloroform to be delivered in a known and less concentrated manner than by open drop on a mask or handkerchief, the specter of death by liver failure was too great to overcome. Thus, chloroform was relegated to the back shelf and not used after a hundred years. Stratmann finishes the story by detailing the modern uses of chloroform in industry and medicine.

Chloroform: The Quest for Oblivion is a novel look at an old anesthetic. While the material is concentrated on the United Kingdom, there is a sense of the American experience as well. For students of the history of medicine, especially those interested in anesthesia, this book helps sort out fact from fiction. The often-confusing tale of the Hyderabad chloroform commissions is here another well-told story that helps the reader understand the motivations of the participants, and, therefore, their conclusions. Like ether, chloroform is one of the pillars upon which modern anesthetic practice was built, and the history of its rise and fall illuminates much about the rise of modern anesthesia.